D4V is a Tokyo-based early stage Venture Capital in partnership with IDEO. Two years ago, D4V invested in healthcare startup Ubie, which develops a service called AI Monshin Ubie. The digital service was created with the goal of reducing the burden on healthcare professionals working long hours, under harsh conditions. AI Monshin Ubie automates a number of patient registration and documentation processes through digital tools, enabling doctors to spend less of their time on manual paperwork, and to dedicate their valuable skills and attention to the patients themselves. Currently, the service is installed in 200 medical institutions in 41 prefectures across Japan.

With AI Monshin Ubie, patients fill out preliminary forms on a tablet, rather than paper, entering information about their health history and current symptoms directly into their digital medical record. As patients fill out the questionnaire, the Ubie AI generates questions in real-time according to patients’ responses, which results in more appropriate and accurate data. The patient’s responses are automatically formatted for the doctor to review prior to and during the consultation. As a result, doctor consultation times and facility operation times are drastically reduced.

With the Coronavirus raising fears of a possible health system breakdown, Ubie has made improvements to anticipate and possibly prevent in-hospital infections. Until recently, Ubie’s services have been primarily used by large hospitals; but in light of the global health crisis, Ubie approached D4V—who partners with IDEO—to help rethink the onboarding experience and quickly facilitate the introduction of AI Monshin Ubie in regional clinics across Japan. D4V and IDEO have been working with Ubie for many years to collaborate in various areas, including UX, rebranding, international research, and more. Therefore, they had a foundation of knowledge from which to build these new features.

Typically, AI Monshin Ubie has been introduced to new hospital clients through direct, in-depth instructional visits from Ubie sales staff. This approach has worked well for rolling out the product to Japan’s 8,000 large hospitals; but for the 100,000 smaller clinics, Ubie needed a more efficient onboarding method to enable staff to get set up smoothly and independently.

During research, D4V and IDEO team members engaged with many different clinic staff members, including full-time doctors, part-time doctors, nurses and receptionists. The researchers found that staff tend to react skeptically to new tools and services, with a common preconception that they will add to their workload. One clinic director’s first impression of AI Monshin Ubie was, “It looks complicated.” But once he actually used the service, he realized that it was very user-friendly.

The team quickly understood that it was important to remove preconceptions by clearly communicating Ubie’s benefits and ease of use. They created a two-minute animation and designed three separate guidebooks. The animation adopted a friendly tone and expressed empathy for doctors, staff members and patients, highlighting how Ubie can bring benefits to each of them. The animation showed how Ubie fits into the existing workflow and explained complex systems in a straightforward and accessible way.

WATCH: A short video clip explains the benefit of their product and service to avoid the users’ concerns in advance.

The guidebook for doctors and directors explains how Ubie’s AI smooths the patient consultation experience and greatly improves the quality of medical care. It also introduces concrete how-tos around set-up, implementation, and ideal workflow. FAQs were also included, addressing concerns about whether or not elderly people would be able to use it.

Ubie business development leader Kenji Yamada says, “D4V and IDEO have a deep understanding not only of design, but of our entire business. They provide inspiration by bringing experience and knowledge that comes from working with other industries and clients outside of healthcare. We appreciate that they can share the knowledge that they’ve obtained with our business.”

Read the Japanese-language version of the Ubie case study here.
When You Feel Unwell, Ask Ubie: Check your symptoms for free
Learn more about Ubie: Global Company Website

In the emergency room, an intervention that’s administered too slowly could cost a patient their life. With COVID-19 fueling a surge in acute respiratory conditions, intubation—a procedure that involves inserting a tube through the mouth or nose and into the airway—is more common than ever. For patients struggling to breathe, the tube can be connected to a ventilator that pumps oxygen to the lungs, keeping them alive.

While a laser-focus on the present is critical for successful patient outcomes, hospitals and physicians often don’t have time to look ahead and anticipate the future of the operating room experience. As technology rapidly improves, there is a ripe opportunity and pressing need to evolve medical equipment to be more innovative and intuitive. Verathon Medical, a global medical device manufacturer, is supporting health care providers at the cutting-edge of care.

Verathon approached IDEO to redesign the existing product system for laryngoscopies and bronchoscopies—procedures that examine parts of the throat through intubation. During these examinations, a tube with a camera embedded in the tip is inserted through the patient’s nose or mouth. The doctor can then see inside the throat on a video monitor, and therefore more easily and quickly intubate and perform the exam.

To create a groundbreaking device, the team observed over a dozen laryngoscopies, bronchoscopies, and intubations. They noticed that many anesthesiologists relied on fixed equipment during the procedures. For example, some had grown accustomed to looking over their shoulder—away from the patient—to view the monitor.

During interviews, physicians and residents expressed difficulties with the current technology, sharing that the small screens aren’t conducive to team viewing or student instruction, and they must often use a separate computer to record patient notes. Others reported frustrating workflows, needing to constantly divert their attention and move their hands between the patient, prep tray, monitor, sterile bin, and disposal bin. These inconveniences and inefficiencies are not only cumbersome, but can increase the risk of infection and fatality.

The team relied on these insights to start designing a next-generation product. Through sketching, storyboarding, and building in real-time alongside doctors and clinic staff, designers quickly teased out additional findings and validated concepts.

This work led to the creation of the GlideScope Core: an all-in-one, portable product system that supports both video laryngoscopies and bronchoscopies. The base of the device—a wheeled cart—has built-in storage units for tools and a disposal bin, offering more mobility and accessibility for medical professionals.

The product’s tagline, “see more, do more,” points to the improvements made to the video system, including a large 10- or 15-inch high-definition touch screen monitor. Displayed images can be enlarged and rotated 180 degrees for improved visualization, team viewing, resident training, and classroom demonstration. To help doctors keep both the patient and monitor in their line of sight, the detachable screen can be secured to an adjustable arm that can be positioned directly over the patient. Additionally, the monitor’s patient annotation feature gives staff access to more of what they need in one device.

The product has been especially valuable for providers and patients during the coronavirus pandemic, when it’s imperative for doctors to keep their distance from patients’ mouths and noses. The GlideScope Core’s movable, detachable, and large, high-definition monitor makes it easier to take this precaution and intubate more quickly. This usefulness is reflected in the 5-fold increase in cart-based device orders for Verathon. While most providers typically order anywhere from 1 to 20 devices for airway procedures, one hospital system requested 600 GlideScope Core systems to meet current intubation demands.

Through modern technology and a focus on human needs, the GlideScope Core supports improved patient outcomes and creates a more seamless operating experience for medical professionals. The product underlines the key but often overlooked fact that often, in order to ensure the healthcare industry is patient-centered, medical device manufacturers and hospitals must also focus on improving the experience of providers.

Healthcare is notoriously difficult to change. Rules and regulations present complex barriers; health practitioners and organizations often have entrenched ways of working; and lives are literally on the line. Despite these significant barriers, the leaders at Newton-Wellesley Hospital (NWH) boldly committed to improving patient care through a new approach.

NWH is a community teaching medical center in Newton, Massachusetts. Because of its proximity to Boston—a city known for world-class healthcare institutions—NWH needed to differentiate itself. The hospital's new president, Dr. Michael R. Jaff, reached out to IDEO for help: "I knew that providing an unparalleled patient experience would set us apart from our competitors." But, Dr. Jaff’s particular approach was unique. He and Dr. Jodi Larson, Chief Quality and Experience Offer (CQXO), saw an opportunity to drive better patient outcomes through cultural and organizational change.

"You cannot learn any more than when you get to listen to your potential patients say why they would never walk into your place." —Dr. Michael R. Jaff

IDEO partnered with NWH for a year of work together, kicked off by defining the vision for NWH and ramping up to in-hospital prototyping and the launch of several new initiatives. A pilot project with the Women's Imaging Center (WIC) focused on solving departmental and employee challenges to provide a better experience for women getting mammograms.

Fueled by this potential, the WIC team redesigned key work processes and created a set of experience principles that inspired new service prototypes. Guided by principles like "Express mutual gratitude" and "Honor every voice," the WIC team tested ways for patients to acknowledge outstanding caregivers and created tools to gather better feedback from patients and adjust quickly. The experience of designing better services inspired the WIC staff to become ambassadors for the power of design thinking across other departments inside NWH and they continue to build on the work through new prototypes and experiments.

Next, IDEO partnered with NWH’s ambulatory surgery group. They took an analogous research trip to Boston’s Logan airport to see with fresh eyes how other high-touch customer service organizations provide customer value in a complex setting. Insights from the trip were applied through live prototyping of several new experiences inside the hospital, including a pre-surgery visit summary and pre-operation care carts.

Analogous research helped us realize that we can learn from other industries and incorporate some (cool) best practices if we allow ourselves to get over the ‘that would never work in the hospital’ mentality. - Dr. Jodi Larson

One of the most impactful prototypes was Care Modes, a tool to empower the NWH care teams to tailor their approach and interaction with patients based on the patients’ unique needs, beyond simply their clinical requirements. Four distinct approaches were identified for engaging a patient before surgery—Explain, Partner, Embrace, and Encourage. The Care Mode is determined based on the provider's understanding of a patient's degree of self-advocacy and their confidence that surgery is the best solution to their issue.

Historically, care providers have been trained to deliver consistent care above all else. However, Care Modes powerfully acknowledge that patients respond differently to different types of care. The Care Modes empower the team—from surgeon to nurse to anesthesiologist—with a clear framework for how to interact with and provide care for patients so they feel most comfortable. Based on the prototype's success with patients and impact on the staff culture, NWH has incorporated Care Modes into EPIC, the hospital's electronic medical record.

The importance of being patient-centered has been central to the healthcare conversation over the past thirty years; but new explorations reveal that there’s far more potential for innovation and improvement when the provider experience is considered in tandem with the patient’s. Each enables the other, and design for both together yields stronger solutions and better outcomes. IDEO's work with NWH demonstrates this vital shift in user-centered healthcare—one can't design services and experiences for patients without designing for their providers’ culture as well. When these go hand-in-hand, meaningful institutional change in healthcare is more than possible.

The mission of Chicago's Museum of Science and Industry (MSI) is to inspire children to achieve their full potential in the fields of science, technology, medicine, and engineering. Leaders at MSI realized they needed to drive day-to-day operations and maintain historic exhibits while focusing on where to go next. To prepare for its next decade, MSI worked with IDEO to create a new business focus to support the museum’s aspirations for the future. The plan would allow MSI to respond to the demands of the marketplace and raise the funds to get there.

At the beginning of the project, MSI laid out its priorities: improve equity of access, enhance the museum experience, and create a more innovative culture. To dive into each of these areas, IDEO conducted immersive research with families, teachers, donors, and staff.

IDEO brought together 60-plus donors, board members, and staff members to engage in a design thinking exercise to unpack and address the tensions that come with choosing a new strategic trajectory. Instead of having a standard ballot vote, the IDEO team encouraged participants to get up and vote with their feet, helping the group of stakeholders physically align on the museum’s new direction.

At the end of the research and prototyping phases, MSI and IDEO developed a vision called Provoking Minds, Inspiring Futures, creating six detailed design briefs to equip MSI teams to bring initiatives forward. The briefs laid out everything from recommending a new Department of Next, dedicated to ensuring that the future is at the heart of everything the MSI does, to MSI Runway, a place for experimental, small-scale, and limited-run exhibits. The ideas were brought to life with an interactive exhibit, built quickly with everyday materials like plywood and circuit boards, to demonstrate that creating an inspiring vision of the future doesn’t have to be an expensive endeavor.

The team also focused on insights that highlighted accessibility issues some families brought up early in the design process—travel across the city via public transportation can be lengthy, and the cost of admission to special exhibits could be prohibitive. To address these concerns, IDEO came up with the Mission Accessible brief: Inspired by casino buses, MSI bus stop signs would be posted in various low-income neighborhoods, signaling a way to take kids and families to the museum for free.

During the project, the IDEO team identified some low-hanging fruit, like rethinking ticketing and improving the student field trip experience, and helped the museum create cross-functional innovation teams to apply design thinking skills towards solving those challenges. They researched, brainstormed, and pushed forward new concepts, meeting weekly to share and build on ideas. At the end of the four week period, each team prototyped their ideas—new outdoor programming, software tools for visiting tour groups—and pitched them to each other.

In 2019, two years after the conclusion of the project, the collaboration paid off. With its new strategic plan and additional resources, the museum has renewed its commitment to serving youth, and MSI’s team, including donors, are aligned on a collective vision of the future. MSI raised more funds than in any previous year, including the single largest gift in its history—$125 million, nearly half of its $380 million fundraising goal—that will help ensure the years ahead.

From New York to Nairobi, educators, parents, and students have been finding ways to keep on learning. Many of the creative workarounds that have emerged in response to the pandemic are more than Band-Aid solutions; they are postcards from the future. Hidden within these adaptations are clues to how education might evolve.

The pandemic has both surfaced new needs and exposed the brokenness of our existing system. As designers who bend towards optimism, we view these needs as opportunities to build back better. We aren’t blindly optimistic, of course. Systems that work well for some and not for others didn’t get that way by accident—they were designed that way and could be reinforced if we aren’t purposeful.

We also know that there are many people out there who are already thinking about possible solutions, so we put out an ask to those doing the work to reform education: How might we adapt to remote learning while also using this moment to radically reimagine what we need our education systems to be?

In just three weeks, we received nearly 450 responses. We heard from parents and students, but also architects and entrepreneurs, whose insights you’ll read in the quotes below. A panel of high school students reviewed promising submissions, and top ideas will receive support from HundrED, Sesame Workshop, the Joan Ganz Cooney Center, TED-Ed, and IDEO to bring them to life. But in the meantime, we were too inspired not to share some of the early ideas with you.

1. Equity will no longer be an afterthought

“When learning from home, not all students have equal time or space to focus on their classwork.” —Kristen Myers, Communication Designer, Chicago, IL

The pandemic has amplified existing equity gaps and brought new ones into stark relief. Simply put: when students are less visible, it’s easier for them to simply disappear. And if a student’s house doesn’t have reliable internet, it doesn’t matter how much they show up ready to learn—the barrier to success is structural. Instead of trying to rectify inequities after they emerge, schools must proactively make decisions that serve students proportional to their needs.

We were particularly inspired by some ingenuity from countries where access to technology is less reliable. The country of Panama, for example, crowdsourced lessons from its best public school teachers and broadcast those classes on national TV. For the last five minutes of each lesson, a special ed instructor explains adaptive techniques for families whose kids have special needs.

By sharing lessons on television, over 6 million students across Panama had access to the country’s best teachers. Innovation doesn’t necessarily mean leveraging the latest technology. Panama’s approach meets students’ needs at scale. In the future, being radically inclusive will be the norm, not the exception.

2. The “classroom” will be everywhere

“Arts centres, museums, libraries, forest schools, universities, they could be used to accommodate small cluster groups (same children and teacher at all times) to help spread the school population across venues in communities.” —Nia Richards, Learning Experience Designer, Wales, UK

With no vaccine yet in sight, returning to a physical campus in the fall is a daunting challenge. But hidden within the challenge to adapt to this new normal hides a larger truth: Schools’ biggest constraints are their own walls.

What if we saw this not as a space constraint but a space opportunity? When you expand the boundaries of the classroom, there’s almost limitless untapped potential. In response to our ask, we received dozens of innovative uses of physical space. From garden classrooms where students can learn from their natural environment to virtual classrooms that connect students from around the world, expanding our perspective on where learning can happen broadens how and what we teach. And when students learn in the context of the real world, they’ll be better equipped to solve real-world problems.

3. Students will manage their own schedules

“The schedule ... It's archaic. It's inflexible. It no longer works in today's society.” —Kevin Varano, High School History Teacher, Lancaster, PA

For the past few months, we’ve all been living in a time warp. Days pass in blinks. Weeks last for months. The markers of time seem arbitrary. But the same was true for students before the pandemic—the school day, school year, and division of subjects are all constructs. The fact that the school day ends at 3pm and has a three-month summer holiday may work for families who can afford childcare and camp, but not for families who can’t. The rigidity of school schedules is a structural barrier to equity.

Then there’s the schedule of the school day. Josh Stern, a rising senior in high school from New York, believes a lot of his work was limited by the demands of the standard school day. During quarantine, he’s been able to do his work when he’s feeling most energized and take mid-day meetings with professionals in fields that he’s interested in pursuing.

During this crisis, students like Josh have been managing their own time while balancing school with hobbies, work, and family care. It will be hard to pull that flexibility back. It’s time for schools to adopt flexible schedules that better meet the needs of students.

4. Schools will support families rather than just the other way around

“Parents (such as myself) became involuntary Teaching Assistants overnight when schools closed. We had no preparation, no experience and, frankly, no clue as it came to teaching.” — Erik Mooij, Parent, Utrecht, Netherlands

If we have learned anything from the past few months, it’s just how hard teaching can be. Families are developing an intimate understanding of all that goes into helping their children learn—and schools are developing an intimate understanding of how ill-equipped they are to help families serve their children. In the future, schools will rethink how they can better support families.

Take Kidappolis, a bilingual learning app that helps families stay engaged in their children’s education through SMS-based updates. When parents are empowered to help their children, not only will families become more invested in their children’s success, but learning outcomes will improve too.

5. There will be new measures of success

“Using standardized tests to evaluate schools exacerbates inequity & distorts educational purpose.” — Hi Howard, Nonprofit Executive Director, Denver, CO

For years, test results have been the metric that matters for teachers, students, and schools. But during the pandemic, the outsized importance of grades, tests, and attendance has paled in the presence of greater needs—like whether a student has a computer to use or enough to eat. We’ve seen how, for students, school and life are not separate entities. It's hard to focus on finishing an assignment when you have to watch over your baby sister. That will hold true on the other side of this global pandemic.

For far too long, we’ve relied on proxies for what students know—courses completed, grade level, and test scores—rather than giving students an opportunity to show what they know. Moving forward, we’re encouraged by competency-based approaches to assessment that reward a broad definition of growth.

We’ve been blown away by the innovation borne out of the constraints of the pandemic. Schools around the world have tapped their communities to buy and distribute hundreds of thousands of laptops to students in need. Remote learning plans that could have taken districts years have been implemented in weeks. Teachers have found ways to bring creativity, joy, and levity to this heavy moment.

Though everyone is rapidly adapting, systemic change is far from guaranteed. Ensuring that student- and family-centered solutions stick will require following the lead of those doing the work. Educators, families, and students have ideas for how to reimagine the future of learning. Let’s use this time to listen to their voices.

Learn more about OpenIDEO’s Reimagine Learning Challenge here. You can also sign up for Challenge updates here.

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In two months, the world of education has shifted faster than it has in the past 200 years. Seemingly overnight, nine out of every ten students in the world were sent home. Elementary school students missed their friends. High school seniors missed prom. College students missed graduation. Teachers lost their classrooms. Parents lost their childcare. One thing not missing, however, was innovation.

This is just one of the many strange and vivid dreams I’ve had since sheltering-in-place in California's Bay Area. I’ve dreamt about accidentally taking a Zoom call while still laying in bed in my pajamas; about fighting off an army of unexpected visitors to my house with a broomstick; and seeking refuge in a leaky submarine to escape an oil spill.

Turns out I’m not the only one having weird and unsettling COVID-19 dreams. Sisters Erin and Grace Gravley decided to track our collective dreams on their website i dream of covid in hopes of finding patterns. I spoke with Grace, who pairs quirky illustrations with each dream posted on the site, about quarantine dream patterns and her predictions for the post-COVID world.

In one sentence, who are you?

A California-born aspiring botanist and unofficial video game expert.

What do you do? How did you learn it?

I am a plant scientist by training and trade, and I would venture to say that anyone with a deep love of botany must also be, on some level, an artist. I first got seriously into drawing and digital illustration as a means of drawing botanical illustrations. These were mostly either to help me remember interesting details about a plant species, but also a bit of a labor of love. Pretty soon I found myself drawing anything from cartoon Valentine’s Day cards to my favorite video game characters. Lots of what I have learned has been through my own trial and error, watching YouTube videos about how the heck Procreate works, and looking at other artists’ works and seeing how they do what they do.

How did the i dream of covid project come about?

This project comes from the mind of my sister Erin. After reading Charlotte Beradt’s The Third Reich of Dreams, a book that chronicled the dreams of people living under Hitler’s regime, she was fascinated by the idea that a shared societal experience could be reflected in the individual unconscious. She decided to create a website cataloging these dreams and asked me to create a logo for her. I volunteered to illustrate the dreams and from then on it has been a collaboration. I have been drawing like a madwoman every day since!

What patterns are you seeing so far?

Many! Some of the most interesting ones that I have noticed are recurring themes about hygiene and windows. The hygiene ones make some sense, as we have been washing our hands more than ever before, and there is some sense of unwashed things being potentially dangerous. They manifest in interesting ways, though, like feeling disturbed by people eating with their hands or having stress-dreams about obsessively scrubbing surfaces to no avail of cleanliness.

The ones with windows really fascinate me. I wonder if they are associated with feeling trapped. Sometimes they show up as beacons of hope, or the place the dreamer is watching the dream play out from. For people who are stuck indoors, especially in cities, a window may be the only “outside” access they have, and maybe that inspires hope. Often these windows appear as sources of evil in these dreams, like the virus is going to come in through the window, or someone is peering outside of the window looking at something scary or horrific.

Could you describe your personal favorite dream from the project?

There are so many great dreams, but my personal favorite is called “In here it is also sad.” This dream was submitted in Portuguese by a dreamer in Brazil and was translated by my polyglot cousin, Philip Georgis. In the dream, the dreamer is dying of illness and is struggling to breathe. They are sitting on a balcony and thinking about everything they’ve experienced in life, and their final sentiment is, “All I could think was that nothing was missing.”

There’s so much fear about how we can ensure our own safety that many of our dreams become about the changes in day-to-day life, or fears that are manifested into objects like shadows or windows. It is interesting and profound to consider feeling at peace with contracting COVID and how that would change our lives and relationships. In the end, it’s a dream about love, community, and loss. I think that resonates with our experiences right now; it cuts to the core of our fears and does so beautifully.

Have you had any weird COVID dreams of your own? What have they been about?

Yes, definitely! I did not start having strange dreams until well into shelter-in-place, but now I am having them pretty frequently. Most of mine are about feeling scared that my mom will find out that I am not following the necessary COVID safety measures. For example, I had one last week where I was going on a date to a baseball game at Oracle Park. We were sitting in the bleachers and I realized that I wasn’t having a very good time. I kept feeling uncomfortable and distracted and was a bit puzzled as to what was bothering me so much. All of a sudden I realized that we were in packed bleachers and doing exactly the opposite of social distancing. I turned to my date and said, “Oh no. If my mom finds out that I am not wearing a mask and am in this big crowd, she’s going to kill me!”

What are your 3 favorite quarantine possessions?

I’m considered essential personnel, so I’m still going in to work every day and am not truly quarantined, so I think my quarantine experience has been different from most folks. But here are mine:

• The Philodendron hederaceum vine that hangs in the window. Watching it grow gives me hope
• The prism that shoots rainbows all over my bedroom every day starting at 3 pm
• My crochet needles and yarn; they ease the tension

How do you see the world post-COVID-19?

This one is tough for me. I talk about it a lot with my friends and family, and I have mixed feelings about it. I worry a lot about the folks who have been and will become disenfranchised because of the pandemic, and about our ability as a country to take care of those people in an equitable and just way.

On the flip side, I have hope for us as a world to be more conscious of those we unfortunately often forget. One of the beautiful things about this situation is that we are paying more attention to the other people in our communities. We worry about those who are elderly, houseless, immunocompromised, and undocumented in a way that we haven’t before. I hope in post-COVID life we continue to do this: to protect those people who need to be protected the most, to care about one another whether we know them or not.

What’s your number one bucket list item once shelter-in-place is lifted?

Camping! I love the outdoors and cannot wait to be able to spend time in nature again.

Who are you creative crushin’ on lately?

Cait Gale of Death or Glory Tattoo in Davis, California. She does classic style tattoos and artwork; she gave me a bison tattoo a few months back that I am very much in love with. I have also been reading a lot of short stories lately, and have been particularly drawn to Edwidge Danticat’s writing. Krik? Krak! is one of the best books I have ever read.

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While in my backyard cleaning, I notice a set of cellar doors propped open slightly by a hose. In my two years of living in this house, I’ve never noticed these doors before. The hose props them open just enough to reveal a world beyond the doors. I almost don’t dare look, but my curiosity gets the best of me. I open the doors and walk down a steep staircase to find an entire apartment, fully furnished, with no signs of occupancy. There’s an art studio, a living area with many, many (too many) couches, a kitchenette, and an office area. It’s small but quaint, and I figure that the previous owner of the house must have abandoned it. Whatever the case, my main excitement is hatching a plan to remodel the space so I could have an office away from my actual house.

The internet has no owner’s manual. For someone new to it, technology can be exciting...but also intimidating. As COVID-19 accelerates the shift to digital across nearly every industry and facet of life, building digital confidence in new internet users is more important than ever. It’s important to the small merchant in Chennai who is now sending photos of their inventory to customers; the mother receiving remittance payments from her son in Jakarta; and the daily wage earner in Dhaka looking for work—all doing so on their phone for the first time.

In collaboration with Google’s Next Billion Users team and the Bill & Melinda Gates Foundation, we set out to help product teams build more inclusive digital services. Together, we created digitalconfidence.design, a suite of design tools to help teams build digital services that work for everyone. Regardless of where they live, what language they speak, or which device they use.

Whether you’re a designer, developer, researcher, or product manager, here are five tools to use when designing or building for the next wave of internet users.

Build empathy with user context cards

The next wave of internet users has unique needs and context—and they may be very different from the users your product team has designed for in the past. For instance, that shopping cart icon you click on to finish a purchase may not ring a bell for someone living in a rural area without a supermarket.

Consider what we learned from Huria, a woman in Kupang, Indonesia, who has always paid the local shopkeeper in cash. When explaining why she didn’t use a digital payment app, she told us, “If I click the wrong button, my money might go somewhere else." For someone used to in-person transactions, the lack of physical artifacts (like receipts and ATM cards) can contribute to a sense that their money isn’t secure, or raise doubts about whether their transactions are successful.

Understanding the needs of users is the first step in designing a product that works for them. How digitally fluent are your target users? What are their typical behaviors? Our user context cards can help your team articulate who you’re designing for by understanding their unique context.

Download the cards here

Align on your challenge with sprint focus cards

Whether you're running a sprint or defining your roadmap, the first step is aligning on the challenge you’ll focus on. Like the unique needs and context, new internet users also face unique challenges when they interact with digital tools for the first time.

Almost a third of all search queries in India are voice searches. “Talking is easy,” a person outside of Jaipur told us, “but typing is hard.” Voice interactions can be error-prone, though, and for someone who’s still figuring out his or her smartphone, that can be alienating; users might even blame themselves.

Many new internet users are also used to learning new skills and troubleshooting problems alongside friends, family, and neighbors. In Bangalore, the Google team met a woman who had just gotten a smartphone. As they sat down to talk with her, they realized she left her phone by the door. They asked if she wanted to show it to them. “Why would I do that until my daughter’s home?” she asked.

As you get to know your users, your team may discover a handful of needs you could address. Choosing which challenge your team will focus on—like optimizing for voice or developing clear onboarding and assistance flows—will help deliver the best product for your end users. This set of sprint focus cards will help your team align on your design challenge by unpacking common obstacles new internet users face.

Download the cards here

Get inspired by other solutions

Creativity often starts with inspiration. How do other apps design for slow, intermittent, or unreliable network connections? How do communication apps account for multilingual users? How do payments apps make complex interactions less overwhelming?

We've curated a selection of inspirational thought-starters and apps to fuel your team's creative process. Browse provocations that’ll spark conversation among your team or check out other apps that are already addressing the real-world challenges of new internet users.

Explore the inspiration tool here

Use design principles cards to guide your decisions

Design principles are the North Star of your solution. They’re an actionable tool to guide your team’s design decision-making. Clear design principles keep the team focused on the needs of end users—like Poonam from outside of Delhi, who told us that digital accounts were confusing. “Why do I need Google to set up my phone?” she asked. Her Android runs on Google software, where having a Gmail account is a prerequisite. But without knowledge of the companies behind the tools, the relationship was hazy, and even a potential barrier to entry.

Our research uncovered the need to let users, like Poonam, “look before they leap.” Users with less digital confidence prefer to try out apps and features without risk before committing. Allowing them to preview experiences will help them discover new possibilities and overcome the fear of doing something “wrong.”

Aligning on design principles that center users with less digital confidence—like offering multiple modes of interaction, providing timely guidance, and celebrating wins early and often—can produce a more accessible and inclusive product. Use the design principles cards to find actionable strategies to guide your work and inform design decisions.

Download the cards here

Measure your effectiveness with the test framework

By now, you have a prototype. It’s time to answer a tough question: How can your team make sure the product you’re building makes a difference for your intended audience?

Answer: Ask your users! Understanding how real people respond to your product is the only way to ensure you’re effectively building digital confidence. A thorough test framework will help you define your testing goals, choose the right methodology, and align on success metrics.

Download the framework here

Building digital services that work for everyone is now more important than ever. We’re inspired by all of the stories we hear of product teams around the world using these tools to design for the next wave of internet users.

As of May 2020, we’ve validated the Digital Confidence Design Tools and methodology with twenty-two product teams, including Google Pay, Flipkart, Airtel, and Hindustan Unilever. Dozens of prototypes built during our tests are being piloted and measured with new internet users around the world—and our hope is that dozens more are built to connect users in emerging markets with everything the internet has to offer.

About Last Mile Money
The Digital Confidence Design Tools came out of Last Mile Money—a five-year innovation initiative between global design firm IDEO and the Bill & Melinda Gates Foundation to connect underserved communities to the digital economy.

About Google’s Next Billion Users team
The Next Billion Users (NBU) team is dedicated to ensuring that Google’s products are meeting the needs of the next billion people coming online. With these needs in mind, the team gathers users insights to build products that help new internet users make the most of the internet. Google's NBU team is also committed to contributing to the ecosystem to create a more inclusive internet where anyone can thrive.

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Today—whatever day you’re reading this—more than a million people will come online for the first time. Tomorrow and the day after, a million more will follow. A million people increasingly from emerging markets and rural areas, where connectivity is on the rise and data costs are coming down. A million people whose first exposure to the digital world is usually through their phone.

As COVID-19 spreads across the world, Amabie has gone viral, with interpretations shared by cartoonists, students, illustrators, craftsmen, even chefs.

Deeply inspired by this act of creative resilience, optimism, and solidarity, we asked IDEO designers across the globe to share their interpretations of the protective creature. If you feel the same, join us in creating your own interpretation of Amabie—and tag @IDEO on Instagram or Twitter.

Felicia Chiao is a San Francisco-based industrial designer by day and illustrator by night.

"My Amabie was drawn traditionally on brown toned paper and colored with Copic Sketch Markers. It was such a strange creature to draw, I just tried not to think too hard about it and have some fun."

Gemma Lord (London, UK) is a designer and occasional color-inner. She really wants a dog.

"I wanted to capture a darker side of Amabie—a Borgesian-like creature, who for centuries lurked in the lesser-known crevices of folklore, and who has suddenly been recast into the uncomfortably bright light of our imaginations in the hope of warding off COVID-19."

Lauren Ito (San Francisco, CA) is a design researcher and community organizer. She can almost always be found by the sea.

"I was inspired by Amabie creating ripples of growth and resilience. As a plant enthusiast and forager, I made an altar collage of natural materials—including many plants propagating in my home as I shelter in place. I hope my amabie interpretation prompts a pause of reflection to honor our collective strength in the face of adversity."

May Kodama (San Francisco, CA) is a graphic designer who likes to doodle a lot.

"This is the self-care Amabie! I wanted to depict an Amabie who was taking good care of herself while sheltering in place, and hopefully encourage others to do the same. Drawn on Procreate and animated in Photoshop."

Tracee Worley (Oakland, CA) is a systems designer at IDEO San Francisco. She finds much design inspiration in ritual, spirituality, and mysticism.

"My Amabie appeared to me in a meditation and told me to visualize her in psychedelic splendor, emerging from a vat of molten gold floating upon the sea. She also told me to set this collage on my bedside table for five days and five nights, so that’s what I’m going to do!"

Luca Ponticelli (London, UK) is a commucation designer and serial doodler. On an average day, you'll find him dissecting the latest political news while sipping on a dark espresso.

"Mythology says she’s the entity announcing epidemics, so I wanted to compare the intensity of the crisis to the power of a sea storm, which she impersonates. The toilet rolls and the face masks, hiding her beak, are pinning this image down to our present day, making it undeniably 2020."

Meagan Durlak (Brooklyn, NY) is a designer director who believes that making is not just about thinking, but about exploring.

"With a symmetrical body, a neutral yet whimsical expression, and textural strokes throughout her bulbous hair, I hoped to capture the essence of the Amabie as a welcoming and warm creature who symbolizes the hope we all need during these uncertain times. She is an imaginary being whose spirit allows us to pin our future dreams and desires onto her elusive existence."

Michelle Lee (San Francisco, CA) leads IDEO’s Design for Play team and is proud mom to 2 budding artists—Neve, who has a full-time gig as a 3rd grader/soccer star, and Ren, who makes his living as a 1st grader/skateboarder.

Michelle’s Amabie (left) embraces her superhero powers, screeching away the coronavirus through acrylic paint and ink atop a collage of today’s newspaper headlines. Neve’s (top right) is a cerebral Amabie, choosing love over sickness, and is conceived through colored pencil and black ink. Ren (bottom right) opts for Amabie’s hairier cousin, bringing him to life with markers on construction paper.

Koko Takatori (Tokyo, Japan) is a design researcher at IDEO Tokyo. She is also a certified scientific illustrator and a cat lover.

"The Amabie illustration from the Edo period depicts it having three fin-like legs. “Three-legged” seems to be a common motif for divine creatures in Japan (like Yatagarasu), so I wanted to emphasize the legs and express its divinity through pen and ink strokes. I also wondered and researched how Amabie could’ve walked with its fin-like legs, resulting in legs that resemble those of pinnipeds. The four Kanji characters mean “warding off disease” and the little red seal says Amabie."

Tiffany Chen and Allison Press (San Francisco, CA and Pittsboro, NC respectively)

Tiffany loves to draw. Allison loves to collage. They combined their favorite artistic flavors into a yummy swirl. Allison collaged a flowery nest, then Tiffany drew an Amabie newly hatched into the scene.

Allison Press (Pittsboro, NC) is a former theater kid pursuing design-powered public service.

"I was inspired by Kirie, the Japanese art of papercutting. I love paper cut art because of its mystery. It creates a scene using only light and shadow. A viewer’s imagination fills in the rest. It felt like a ripe medium to depict a mythical, centuries-old creature like Amabie."

AJ Mapes (Oakland, CA) is a designer in IDEO's learning studio.

"I'm interested in exploring contrasts, so for my interpretation I wanted to see what Amabie might look like if drawn with clean geometry and organic textures."

Mark Dingo Francisco (Tokyo, Japan) is a visual communication designer at IDEO Tokyo. With a background in illustration, graphic design, branding and identity, Dingo aims to provide clear, effective, and emotive storytelling.

"My interpretation of Amabie aims to convey the surrealness of the COVID-19 situation along with the phenomenon of drawing Amabie’s portrait as a ripple effect, while maintaining an aquatic vibe to harken back to its yokai roots."

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In the fight against COVID-19, a sea spirit monster called Amabie (Ah-mah-bee-yay) has emerged from 19th-century Japanese folklore as a symbol of hope, a public health mascot, and an internet meme. According to legend, Amabie appeared to a government official in 1846, predicting six years of good harvests followed by a wave of diseases. In order to stave off disease, Amabie left instructions that people should draw its image and share it far and wide. The creature's common features include a beak, long hair, and fin-like legs. The rest is up to the artist.

I help organizations cut through complexity by shaping how they show up, through brand strategy, identity, and storytelling.

Working at the intersection of brand and business, I bring an editorial eye and a bias toward making—turning ideas into tangible experiences that people can understand, trust, and believe in.

My work spans government, healthcare, financial services, media, and consumer goods, from launching Gen Z-focused ventures to building innovation labs and reimagining legacy brands. I relish moments of ambiguity and enjoy translating across teams, perspectives, and priorities to move ideas forward.

I started my career in editorial and digital design, shaping cross-platform experiences and identity systems in publishing and agency environments. That foundation still shapes how I work today: I’m detail-oriented, collaborative, and overreliant on the Oxford comma. I hold a BFA in Visual Communication from the School of the Art Institute of Chicago.

For 25 years, I've asked the same question: Who does this design exclude—and what are we going to do about it?

My work spans human-centered strategy, inclusive design, and qualitative research, with clients ranging from Microsoft, Google, and Verizon to the National Science Foundation, and San Francisco Unified School District.

Before IDEO, I taught elementary school in East Palo Alto and spent a decade doing design work with social service organizations—where I learned firsthand what it costs people when systems are built without them in mind.

I am currently writing User Error, a nonfiction book about digital access and the design decisions behind it. I live in Oakland, California.

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My expertise spans brand, communication, and product design across tech, education, the arts, and social impact.

I believe great work demands both high-level vision and obsessive attention to detail, and only happens through collaboration.

I bring an inclusive, hands-on approach and a deep understanding of business, which enables me to consistently deliver excellence while always asking why.

Before joining IDEO, I worked at the brand firms Pentagram and VSA Partners. I began my career as a designer, leading teams at the School of the Art Institute of Chicago and the Milwaukee Art Museum. I hold an MFA in graphic design from Maryland Institute College of Art and a BFA in communication design from the Milwaukee Institute of Art & Design, and have taught at some of the best design schools in the US.

I am responsible for IDEO’s long-term success in China and working with clients to use design as a tool to enable growth. Specifically, I have helped Chinese companies design holistic brand solutions through the development of their products, communication, services, and innovation teams, and I have helped multinationals expand their presence and influence in China.

I advise global leaders on developing China-led innovation and capabilities.

In over 15 years in IDEO Shanghai, I have worked on projects that use design to elevate the quality of the experience of healthcare products and services, streamline processes that increase productivity, create spaces and programs that promote and enable inclusive communities, and build next generation mobility solutions that are planet-positive.

Before joining IDEO, I worked at Philips Electronics and the Electrolux Group in Italy, the Netherlands, and Singapore on a number of breakthrough commercial products. I am a member of the Young President Organization in Shanghai.